[Many poor rural Southern communities lack a decent water and
sewage infrastructure; consequently, poverty-related infections, or
“neglected tropical diseases,” have been discovered in
southeastern Texas, Alabama, Mississippi, and Louisiana. ]
[https://portside.org/] 

 NEGLECTED TROPICAL DISEASES: THE RURAL SOUTH’S INVISIBLE PUBLIC
HEALTH CRISIS  
[https://portside.org/2018-07-14/neglected-tropical-diseases-rural-souths-invisible-public-health-crisis]


 

 Lyndsey Gilpin 
 July 9, 2018
Southerly Magazine
[https://southerlymag.org/2018/07/05/the-rural-souths-invisible-public-health-crisis]


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 _ Many poor rural Southern communities lack a decent water and sewage
infrastructure; consequently, poverty-related infections, or
“neglected tropical diseases,” have been discovered in
southeastern Texas, Alabama, Mississippi, and Louisiana. _ 

 A lot of rural Southern communities, from the Black Belt to
Appalachia, lack basic sewage and water systems., Clancy Calkins 

 

_This story is the first in a series on ways communities are
addressing the rise of poverty-related tropical diseases related to
poor sewage infrastructure in the rural South. _

When Pamela Rush flushes her toilet, the waste flows out the back of
her sky blue mobile home through a yellowing plastic pipe and empties
just a few yards away in a soggy pit of mud, weeds, and dead grass. 

On a hot day in mid-May, Rush walked around her yard in rural Lowndes
County, Alabama. Flies and mosquitoes swarmed her as she tiptoed near
the pit. The smell of sewage was overwhelming. 

Rush, 48, a soft-spoken woman with striking brown eyes, has
straight-piped her family’s waste into her yard for almost two
decades. Her home is on the edge of clay dirt road in the dense
Alabama forest, miles from a municipal sewer system. Since Rush
struggles with her health and is unable to work, she can’t afford
the thousands of dollars it would cost to install an on-site septic
system. This is her only option. 

Mold grows throughout her house because of the damp, dark conditions,
causing multiple respiratory problems for Rush and her two children.
“I go to sleep in fear every night,” Rush said as she stared at
the pit in her backyard, wiping sweat from her brow. “It don’t
ever leave my mind.”

In the rural South, these conditions aren’t uncommon. Many
communities from the Black Belt to Appalachia lack basic sewage and
water infrastructure. In economically distressed regions like Lowndes
County, it’s led to a surge in poverty-related tropical diseases
often found in developing countries. Doctors and researchers have
observed significant levels of parasitic infections like hookworm and
toxocara and conditions for mosquito-borne illnesses like Zika and
West Nile.

The risks are accelerated by erratic precipitation patterns and
warming temperatures caused by global climate change. But local,
state, and federal governments offer little funding to update
infrastructure and local health departments have, so far, done little
to address this public health crisis, forcing activists and
researchers to address it themselves.

“In most countries in the Western world, it’s assumed governments
will one way or another make sure basic facilities like clean running
water, sewage, and sanitation are available,” said Philip Alston,
the Special Rapporteur on extreme poverty and human rights for the
United Nations. In 2017, he traveled to Lowndes County for a report on
U.S. poverty. 

“What was striking to me in Alabama was the extent to which
there’s no sense that a government should be working towards
providing basic infrastructure,” Alston said. “If you happen to
live in one of the big cities, you will get access, but if you
don’t—and particularly if you live in one of the poor counties
like Lowndes—there isn’t any obligation and there are no plans in
place.”

The Black Belt, named for its rich, dark soil that makes for fertile
agricultural land brought white farmers, their plantations, and,
forcibly, their slaves, to Alabama. In the 1960s, that same land
became the foundation for the Civil Rights movement. Most of the
54-mile highway between Selma and Montgomery, where Martin Luther
King, Jr. and hundreds of supporters marched for voting rights in
1965, is in Lowndes County. It is home to Tent City, where black
sharecroppers lived after being kicked off their land by white
farmers, and to the Lowndes County Freedom Organization, which later
became the Black Panther Party. 

Today, Lowndes County
[https://www.census.gov/quickfacts/fact/table/lowndescountyalabama/PST045216] has
a population of about 10,000 people, 73 percent of whom are black.
Nearly 32 percent of people live in poverty. The once-coveted soil is
now the reason many people like Rush live in dangerous conditions: the
ground isn’t very permeable to water. Typical septic systems don’t
work as well, a problem exacerbated by excessive rainfall.

Poverty is more concentrated and higher in the South than other areas
of the U.S. According to the Census Bureau
[https://www.usnews.com/news/best-states/slideshows/the-10-states-with-the-highest-poverty-rate],
the South has seven of the top ten states with the highest poverty
rates. Slavery and Jim Crow laws created a glaring racial wealth gap
that still exists today, although both black and white populations in
the region have exceptionally low rates of upward economic
mobility, according to the Equality of Opportunity Project
[http://www.equality-of-opportunity.org/assets/documents/race_summary.pdf].

Many of these communities, isolated in the Appalachian Mountains or
the Mississippi Delta, are unincorporated and therefore lack access to
municipal infrastructure or have failing infrastructure. For instance,
Alabama has more than 800,000 private septic systems for people not
hooked up to municipal wastewater systems. About a quarter of them
are failing
[https://www.infrastructurereportcard.org/state-item/alabama/]. 

That number isn’t unusually high for a rural Southern state, said
Mark Barnett, a professor of environmental engineering at Auburn
University and American Society of Civil Engineers (ASCE) member. In
the Black Belt, it’s “even harder for rural residents to afford
and maintain working septic systems,” Barnett said, so finding ways
to install, repair, and rehabilitate sewer and wastewater treatment
plants are top priorities.

With ASCE, Barnett lobbies legislators to fund rural infrastructure
improvements. President Trump said his $1.5 trillion infrastructure
plan will fund these, but the 2019 infrastructure budget proposal
[https://www.cnbc.com/2018/01/30/trump-infrastructure-plan-here-is-a-preview.html] only
allots about $200 billion. A quarter of that will be released in block
grants for unspecified rural programs all across the U.S. To replace
each one of Alabama’s 200,000 failing septic systems would cost
between $10,000 and $20,000. Alabama would need a grant for up to $4
billion, or about 8 percent of the federal budget. Other water
infrastructure needs, like those of dozens of counties in
Appalachia, could cost millions each
[https://www.scalawagmagazine.org/2018/03/kentuckys-rural-water-disaster-could-get-worse-before-it-gets-better/].
 

“These aren’t inherently unsolvable problems—we’re not trying
to send anyone to the moon,” Barnett said. “It’s just a matter
of will and continued funding. We know how to design and we even have
ones that work well in low permeability soils, but all of those things
are expensive.”  

According to Special Rapporteur Alston, infrastructure access has a
massive impact on development and justice. 

“Infrastructure enables people to live decent lives, and it also has
great economic benefits,” Alston said. “They become more
productive workers at a higher level, and the economy benefits from
that as well.”

Less than a decade ago, Dr. Peter Hotez, founder of the National
School of Tropical Medicine at Baylor College of Medicine, coined the
term “neglected tropical diseases.” It refers to about 40 chronic
and debilitating infections that occur in poverty-stricken places and
also cause poverty due to long-term effects on productivity, child
development, and pregnancy outcomes.

“I thought I knew what poverty looked like, but [the rural South]
was a different animal with low-quality housing and environmental
degradation,” Hotez said. “I thought there had to be tropical
diseases here if you took the time to look. The problem was no one was
willing to go into these poor areas to see if these diseases were
here.” 

He was right. His team discovered tropical diseases throughout
southeastern Texas and Gulf Coast states like Alabama, Mississippi,
and Louisiana. In Lowndes County, they found one third of 55 people
tested positive for hookworm
[http://www.ajtmh.org/content/journals/10.4269/ajtmh.17-0396], a
parasite spread through fecal matter in soil, and also found evidence
of toxocariasis, spread through stray dogs and cats. In Houston and
other places, researchers have seen cysticercosis, a tapeworm
transmitted through human feces; murine typhus, a bacterial infection
spread by fleas; Chagas disease, an infection that can lead to heart
failure, spread through “kissing bugs” that live in lush
vegetation; West Nile virus and Zika, spread through certain mosquito
species. 

The rates of these diseases are likely to be exacerbated by the
effects of climate change. According to a 2017 study in _Science_
[http://science.sciencemag.org/content/356/6345/1362], the American
South stands to see the most economic losses from climate change. It
predicts many counties
[https://www.nytimes.com/interactive/2017/06/29/climate/southern-states-worse-climate-effects.html] will
see 5 to 15 percent damages to their gross domestic product per year
by the 2080s. More frequent extreme weather events like Hurricanes
Harvey in Texas and Irma in Florida and Puerto Rico are hitting
Southern coasts causing flooding and storm damage. A 2015 Climate
Central study
[http://sealevel.climatecentral.org/uploads/ssrf/AL-Report.pdf] showed
Alabama alone has thousands of vulnerable people and billions of
dollars worth of property and infrastructure at risk of flooding. 

Although Rush hasn’t yet been involved in a study, she suspects she
and her children suffer from the conditions they’re living in. Her
daughter has to be taken to Birmingham—three hours away—for sleep
apnea treatments. Her 16-year-old son just graduated from middle
school after being held back twice. Recent research
[https://www.uptodate.com/contents/mass-drug-administration-for-control-of-parasitic-infections?csi=bbd30146-3ccb-4d2a-8926-dd8454c61154&source=contentShare] shows
that soil-transmitted parasites like hookworm can cause developmental
delays in children.

In May, the Alabama Department of Public Health announced
[http://www.wsfa.com/story/38243293/adph-begins-community-survey-in-lowndes-county] it
is teaming up with local officials in Lowndes County to run a survey
about sewage infrastructure and public health. But Rush and several
other local residents said they’ve never heard from local officials
about addressing the issue. 

Cantrell McAlpine, a Lowndes County public service commissioner who
has lived in a rural part of the county since 1982, said that the
local health department does not remain in contact with residents,
which has led to a lack of supervision over how septic systems are
installed or maintained. 

“It’s something that could be rectified, but we need a good active
health department with proper follow-ups to help people understand
what you have to do,” McAlpine said. 

The Lowndes County Public Health Department did not respond to request
for comment. An Alabama Public Health Department spokesperson said
that the agency and local health departments work with residents to
bring septic systems into compliance. 

According to Kristie Gutierrez, a science education professor at Old
Dominion University who led a study
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772209/] on climate
justice in the rural Southeast, tackling environmental injustices like
poor sewage infrastructure and public health crises must begin with an
understanding of how climate change is discussed in the South. 

“Rural communities are very individualist in that they know they
need to work on taking care of themselves and not solely rely on the
government to do things for them,” Gutierrez said. “Where types of
meetings will take place, like churches or schools, getting people to
come and enjoy conversation and community—that’s very important in
rural regions and in the South.”

With the local leadership of Catherine Flowers, who founded the
Alabama Center for Rural Enterprise and works for the nonprofit Equal
Justice Initiative, partnerships have formed between Duke University,
Baylor College of Medicine, community groups and engineering experts
to tackle technical and policy solutions to Alabama’s public health
crisis and others like it across the South. 

“We have collaborations on trying to find solutions,” Flowers
said. “Some people say you’re excusing the government, they should
be the ones doing it. But when they’re not doing it, what do we do?
We can’t leave people to die, or to be sick.” 

This year, National School of Tropical Medicine researchers will test
300 children in Lowndes County for hookworm. Researchers and engineers
are also looking for more affordable ways to build septic systems, and
holding more community events to spur conversations and ideas.

Rush hopes to play a small role in finding some sort of solution. By
speaking out about straight-piping, she faces the possibility of being
fined by the public health department, but she said she no longer has
any choice. It’s the only way people will find out that she and her
family live in these conditions. There are many others like them in
remote places across the South. 

“A long time ago, I was ashamed about it, and didn’t want anybody
looking at this stuff,” Rush said, peeking through a frayed curtain
over a cracked window to see her son. “But I had to come out of my
shame. God gives me strength. I hope it will happen in my lifetime. It
might.”

_This series is supported by the __Solutions Journalism Network_
[http://solutionsjournalism.org/]_, a nonprofit organization dedicated
to reporting about responses to social problems. _

_See Southerly Interview [https://youtu.be/UM3YDyhJs_w] with Dr. Peter
Hotez, National School of Tropical Medicine. Video by Clancy
Calkins._

[_Lyndsey Gilpin is the editor and publisher of Southerly. Based in
Louisville, Kentucky, she travels throughout the American South to
report on climate change, environmental justice, energy, economic
development, and rural and urban issues. Her work has appeared
in Harper’s, Vice, The Daily Beast, CityLab, High Country News,
FiveThirtyEight, The Washington Post, Hakai, The Atlantic, Grist,
Outside, and InsideClimate News._]

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